A pathological complete response in malignant pleural mesothelioma after combination chemotherapy with Carboplatin and pemetrexed

Our plain-English summary of A pathological complete response in malignant pleural mesothelioma after combination chemotherapy with Carboplatin and pemetrexed, by S.C. Kao, B. McCaughan, A. Muljono, et al (Journal of Thoracic Oncology, 2010).

The study

• Authors: S.C. Kao, B. McCaughan, A. Muljono, M. Boyer
• Journal: Journal of Thoracic Oncology
• Published: 2010;5(3):405-6
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This case report, by doctors in Sydney, Australia, described one patient: a 57-year-old nonsmoking man with previous asbestos exposure. The article gives no details of fiber type, job or amount of exposure. A biopsy confirmed malignant pleural mesothelioma of the epithelioid subtype, and a CT scan showed disease only in the right side of the chest. The patient received six cycles of pemetrexed and carboplatin every 3 weeks. Carboplatin was used because of existing hearing impairment. Side effects were grade II anemia and grade I fatigue and nausea. A follow-up scan showed a partial response. Four weeks after chemotherapy, surgeons removed the right lung and pleura (extrapleural pneumonectomy). Examination of the removed tissue found no remaining cancer, and no radiotherapy was given afterwards. The patient remained well, with no sign of recurrence, one year after surgery. The authors acknowledged that mesothelioma is often difficult to diagnose, but cited two independent pathology reviews. They concluded they believed this was the first reported complete pathological response after carboplatin and pemetrexed, and that carboplatin seems a reasonable alternative when cisplatin cannot be used.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 57-year-old nonsmoking man with previous asbestos exposure and malignant pleural mesothelioma of epithelioid subtype, treated by doctors in Sydney, Australia (dates not given)
• Exposure: Previous asbestos exposure, with no fiber type, job or dose given. The treatment studied was six cycles of pemetrexed (500 mg/m2) and carboplatin (area under the curve 5) every 3 weeks, followed by extrapleural pneumonectomy.
• Main results:
  • The biopsy confirmed malignant pleural mesothelioma of epithelioid subtype, and the CT scan showed disease in the right hemithorax only
  • Carboplatin was used because of preexisting hearing impairment
  • Side effects of chemotherapy were grade II anemia and grade I fatigue and nausea
  • The restaging CT scan after chemotherapy showed a radiologic partial response
  • Extrapleural pneumonectomy was performed 4 weeks after chemotherapy
  • Examination of the removed lung, pleura, lymph nodes and port site showed no residual malignancy (pathological complete response)
  • No adjuvant radiotherapy was given, and the patient remained well without evidence of recurrence 1 year after surgery
• The authors' conclusion: The authors believed this was the first reported case of a pathological complete response in malignant pleural mesothelioma after carboplatin and pemetrexed. They concluded that, where cisplatin is contraindicated, carboplatin seems a reasonable alternative in combination with pemetrexed.
• Limitations the authors state:
  • The authors acknowledged that the pathologic diagnosis of mesothelioma is often difficult. They supported the diagnosis with two independent pathology reviews of the biopsy, immunohistochemistry, and the clinical and radiologic picture.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Carboplatin, Pemetrexed (Alimta).

Related studies

• Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma — S. Kruger, M.K. Angele, et al. (2014)
• Synergistic antitumor activity of recombinant human Apo2L/tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in combination with carboplatin and pemetrexed in malignant pleural mesothelioma — G. Pasello, L. Urso, et al. (2014)
• Pathological complete response in malignant pleural mesothelioma patients following induction chemotherapy: Predictive factors and outcomes — B. Lau, S. Kumar, et al. (2017)
• Carboplatin plus pemetrexed as first-line treatment of patients with malignant pleural mesothelioma: a phase II study — N. Katirtzoglou, I. Gkiozos, et al. (2010)
• Malignant mesothelioma, hypoalbuminaemia and the effect of carboplatin/pemetrexed on survival — S. Murphy, G. Probert, et al. (2013)
• Correlation between TS, MTHFR, and ERCC1 gene polymorphisms and the efficacy of platinum in combination with pemetrexed first-line chemotherapy in mesothelioma patients — T. Powrózek, D.M. Kowalski, et al. (2014)

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